背景:pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益,分析影响pT1N1M0胃癌患者预后的危险因素。方法:从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 G...背景:pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益,分析影响pT1N1M0胃癌患者预后的危险因素。方法:从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 GC患者319例。采用Kaplan-Meier法和log-rank检验分析总生存率。采用Cox比例风险回归模型对影响pT1N1M0胃癌根治性切除患者预后的因素进行单变量和多变量分析。结果:生存分析显示术后辅助化疗(5年OS:52.4% vs. 75.8%,p 0.05)。结论:术后辅助化疗及辅助放疗能够改善pT1N1M0 GC患者OS,年龄、辅助化疗、肿瘤部位、ELNC是pT1N1M0胃癌预后的独立影响因素。Background: Currently, there is no consensus on postoperative adjuvant therapy for pT1N1M0 gastric cancer in major guidelines. The aim of this study is to determine the survival benefit of adjuvant chemoradiotherapy in patients with pT1N1M0 gastric cancer after radical gastrectomy, and to analyze the risk factors affecting the prognosis of patients with pT1N1M0 gastric cancer. Methods: A total of 319 patients with pT1N1M0 GC after gastrectomy from 2004 to 2019 were selected from the SEER database. Kaplan-Meier method and log-rank test were used to analyze the overall survival rate. Univariate and multivariate analyses of prognostic factors of patients with pT1N1M0 gastric cancer after radical resection were performed using Cox proportional hazards regression model. Results: Survival analysis showed that postoperative adjuvant chemotherapy (5-year OS: 52.4% vs. 75.8%, p 0.05). Conclusions: Postoperative adjuvant chemotherapy and radiotherapy can improve the OS of patients with pT1N1M0 GC. Age, adjuvant chemotherapy, tumor location, and ELNC are independent prognostic factors for pT1N1M0 gastric cancer.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
文摘背景:pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益,分析影响pT1N1M0胃癌患者预后的危险因素。方法:从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 GC患者319例。采用Kaplan-Meier法和log-rank检验分析总生存率。采用Cox比例风险回归模型对影响pT1N1M0胃癌根治性切除患者预后的因素进行单变量和多变量分析。结果:生存分析显示术后辅助化疗(5年OS:52.4% vs. 75.8%,p 0.05)。结论:术后辅助化疗及辅助放疗能够改善pT1N1M0 GC患者OS,年龄、辅助化疗、肿瘤部位、ELNC是pT1N1M0胃癌预后的独立影响因素。Background: Currently, there is no consensus on postoperative adjuvant therapy for pT1N1M0 gastric cancer in major guidelines. The aim of this study is to determine the survival benefit of adjuvant chemoradiotherapy in patients with pT1N1M0 gastric cancer after radical gastrectomy, and to analyze the risk factors affecting the prognosis of patients with pT1N1M0 gastric cancer. Methods: A total of 319 patients with pT1N1M0 GC after gastrectomy from 2004 to 2019 were selected from the SEER database. Kaplan-Meier method and log-rank test were used to analyze the overall survival rate. Univariate and multivariate analyses of prognostic factors of patients with pT1N1M0 gastric cancer after radical resection were performed using Cox proportional hazards regression model. Results: Survival analysis showed that postoperative adjuvant chemotherapy (5-year OS: 52.4% vs. 75.8%, p 0.05). Conclusions: Postoperative adjuvant chemotherapy and radiotherapy can improve the OS of patients with pT1N1M0 GC. Age, adjuvant chemotherapy, tumor location, and ELNC are independent prognostic factors for pT1N1M0 gastric cancer.
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
